Active surveillance followed by delayed curative treatment for those who develop evidence of significant prostate cancer progression, is now a recognised management strategy for a select group of men with low risk prostate cancer.
The prognosis of prostate cancer has changed dramatically over the last few decades. Recent advances in cancer detection and prostate specific antigen blood test screening has resulted in the diagnosis of many men with small slow growing prostate cancers, which may never be a threat to your health or life expectancy.
Treatment of this low risk prostate cancer (over treatment) can lead to potential serious complications of surgery, without the benefit of life expectancy. Therefore, with low risk prostate cancer many urologists now recommended an approach of “active surveillance”. This does not mean that we totally ignore your prostate cancer, but simply means we follow your cancer until it progresses to a stage where it could possibly be a threat to your life, at which time curative treatment would be recommended. This means there are a lot of men who are diagnosed with prostate cancer who will never require treatment and therefore never suffer the potential side effects of treatment such as loss of erections and incontinence of urine.
Low grade prostate cancer is a common finding in autopsy studies of gentleman who die from other causes. Therefore, we now understand that not all prostate cancers need treatment.
Obviously you may be concerned about the risk of cancer spreading to other parts of your body if you are not treated and this is quite an understandable concern. However the findings of a Canadian study of over 450 men by a urologist called Klotz, has shown that the probability of living for 10 years after diagnosis of a low grade prostate cancer is over 97%.
With improved technology for staging of prostate cancer, such as MRI scans, it is unlikely that a life threatening cancer will be missed or will rapidly progress to another part of your body during the active surveillance protocol. This is true if you keep to strict urological follow up and an active surveillance protocol, which will include regular prostate blood tests (PSA) and regular surveillance tests to exclude an increase aggressiveness of your prostate cancer, such as regular MRI scans and regular prostate biopsies.
How do I know I am suitable for active surveillance
Patients with low risk prostate cancer are suited for active surveillance. These are men usually with a PSA of < 10, who have a prostate that feels normal on digital rectal examination (stage T1c) and with a Gleason score of 3 + 3. Occasional patients with a low volume of Gleason score 3 + 4 cancer, particularly in gentleman over the age of 70, may be considered suitable for active surveillance in certain circumstances.
Triggers for intervention
The largest problem with the concept of active surveillance is the definition of a clinically significant progression of your cancer, which may be a threat to your life expectancy. A number of triggers have now been proposed to determine which men will need to proceed with treatment.